Postural & Gait Disturbances

On June 8, Nir Giladi and Evzen Ruzicka chaired a session entitled, "Gait and balance impairment in movement disorders:  From laboratory to clinic".  In his talk, Bastiaan Bloem presented the hypothesis that gait and balance impairment are cognitive, not motor, disorders.  Complications from gait and balance disorders (such as falling) can cause increased anxiety.  Futhermore, increased anxiety (about falling, or other causes), can contribute to increased falling.  Generally, in the course of disease progression, people compensate for gait and balance impairment in various ways, by walking slower and standing straighter. When these corrective strategies start to fail, incidents of falling increase: Bloem notes that this typically coincides with the development cognitive dysfunction in Parkinson's disease dementia.

Cueing training was discussed as an important way of dealing with gait and balance impairment when other compensatory mechanisms fail.  Nir Giladi, in his talk entitled "Man on the moon:  Current and future management of gait and balance impairment", spoke about the use of virtual reality combined with treadmill training to induce cueing, which not only assists with gait and balance problems, but also productively engages cognitive processes.  In the future, a combination of traditional training methods with additional enhancements of the cognitive state will be critical. 

Pertinant references are cited below.

It has been observed clinically that patients with postural instability and gait disturbances (PIGD) represent a PD subtype which is often characterized by a more malignant course of PD with significant cognitive decline.  Can differences in cognitive mechanisms between this subtype and the more tremor dominant subtype be useful for alleviating gait and balance difficulties?